The meaning of patient-nurse interaction for older women in healthcare settings: A Qualitative Descriptive Study

Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective

BACKGROUND

Nursing care for older women represent a challenge worldwide due to its characteristics. When communication is impaired between primary care nurses and older women living alone, an imbalance in power relations occurs. The main objective of this study is to analyse the power relations between older women and primary care nurses in situations of active listening, shared decision-making and participation in care.

METHODS

We developed a qualitative study in southern Spain using a discursive and gender approach. We used purposeful sampling to interview older women who lived alone and received home nursing care. Simultaneously, we conducted focus groups with primary care nurses who provided home care to older women. A linguistic analysis of the transcripts was carried out.

RESULTS

Nine semi-structured face-to-face interviews were conducted with older women who lived alone and two face-to-face focus groups with four primary care nurses in each. The discourse of the participants demonstrated an imbalance in power relations. Influenced by work overload, active listening was considered a privilege in primary care nurses´ discourse. Regarding shared decision-making, older women´s discourses revealed "mirages" of real situations where they thought they were deciding. Participation in care was difficult since older women saw themselves as a nuisance in nurses´ presence, and primary care nurses did not facilitate older women's engagement. Older women weren´t considered when organising home visits and had interiorised a subordinated feeling. Similarly, a strict sense of identity made primary care nurses feel powerful in their relationships with older women.

CONCLUSIONS

The discourse of older women represented them as victims of a hostile panorama whilst they were sometimes satisfied with the deficient care received. The discourse of primary care nurses used more discursive strategies to represent themselves as professionals committed to caring. However, it also revealed deficiencies in care, discriminatory elements, and feelings of being limited by their working conditions. Active listening to older women and engagement in decision-making readjust empower the older women. Attending to the needs and concerns of primary care nurses could recalibrate the power imbalance between them and healthcare organisations.

The Effects of Nurses' Perception of the Older Adults and Work Stress on Nursing Competency of Nurses Who Care for Older Adult Patients at General Hospital

The older adult population is rapidly increasing in South Korea, and hospitalization at general hospitals is increasing too. Therefore, nurses working at general hospitals need the nursing competency for older adult patients. The study was conducted to examine the effects of nurses' perception of the older adults and work stress on the nursing competency of nurses at a general hospital, South Korea. A cross-sectional, descriptive correlational design was employed. Participants were a total of 136 nurses working at a general hospital located in Seoul, South Korea. Measures used in the study were the study participants' general characteristics survey, Korean version of the Attitude Toward Old People Scale (KAOPS), the work stress scale, and the nursing competency scale. Data were collected from February to March, 2021. The regression model was statistically significant, and the explanatory power of the regression model was 33%. The significant factors affecting nursing competency were education level, perception of the older adults, and work stress. The greatest affecting factor was education level, followed by perception of the older adults and work stress in order. Nurses caring for older adult patients at general hospitals should pay attention to affecting factors to help improve the nursing competency in clinical practice. Managers should improve relevant policies to ensure that nurses have more opportunities to participate in the practical training of older adult care and explore effective training methods to improve the nurses' perception of older adults.

Nurse-patient interaction during the Covid-19 pandemic: Creating and maintaining an interactive space for care

AIMS

To explore nurse-patient interactions during the Covid-19 pandemic from both nurses' and patients' perspectives.

DESIGN

Qualitative study using constructive grounded theory.

METHODS

A total of 34 patients and 49 nurses from acute and home care settings participated in individual or focus group interviews between December 2020 and May 2021. Data were analysed by a team of researchers using coding, memo-writing, theoretical sampling and constant comparison and integration.

RESULTS

We identified the creation and maintenance of an interactive space as the main social process. This interactive space was shaped by the care context and the course of the pandemic. For nurses, four factors were key, namely protecting oneself and others, navigating communication barriers, adapting nursing actions to the evolving situation, and providing emotional care work. Patients experienced attentive caring relationships with nurses and felt that, for the most part, their individual needs had been met despite the pandemic challenges.

CONCLUSION

Nurses and patients created an interactive space in which they were able to provide and receive the necessary care. Maintaining the interactive space was often challenging, and required an intentional effort by nurses, particularly in acute care settings. The findings illustrate that nurses ensured the provision of necessary care even during a public health crisis, thereby enabling patient access to good quality care.

IMPACT

Nurse-patient relationships are important for effective, person-centred care delivery. Despite the pandemic challenges, nurses managed to uphold their caring imperative and ensure quality care. Findings provide further insights on the importance of nurse-patient interaction in maintaining quality care. They inform models of nursing care delivery and strategies to support quality care during public health crises.

Mutuality in nursing: A conceptual framework on the relationship between patient and nurse

AIMS

To describe and develop a conceptual framework for the process of mutuality between nurse and patient.

DESIGN

This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014).

METHODS

A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size.

RESULTS

A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions.

CONCLUSION

This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.